The time has come for specialist paediatric GPs
Dr David Jones presents the case for specialist paediatric GPs.
Children in the UK have some of the worst health outcomes of any European country says Dr David Jones, who presents the case for specialist paediatric GPs
A few years ago a local director of children's services asked me what GPs 'did for children'? It was a good question to which I mumbled something about treating sore throats and earache, and then remembered that we also immunise them!
The point was I couldn't provide a coherent response because neither I, my practice, or my profession had one. I might have been able to say what we did for patients with COPD or CHD, or any other QOF-based activity, and therein lies part of the problem. There is virtually nothing in the QOF for children, skewing priorities and relegating their health needs to lower division status.
Another important factor is the lack of GP registrars undergoing paediatric training (a miserly 40%), something the RCGP and RCPCH are trying to sort out presently. Coupled with minimal GP involvement in maternity care, there is a danger of losing the ‘family' bit of ‘the family doctor'.
But is there any evidence that any of these factors adversely affect the care GPs provide? Nothing concrete, but children in the UK have some of the worst health outcomes of any European country, a startling fact that anyone involved in the care of children should sit up and take note of.
No-one is saying this is solely because of care provided by GPs, but it's noteworthy that death rates from illnesses that rely heavily on first access services are higher in the UK that in many other European countries. All agencies and individuals have a responsibility to look at their practice and see if more can be done to rectify this unsatisfactory situation. For our profession this means having a critical look at training and competency.
A couple of years ago some SHAs recommended 'children's GPs' in their sick and injured child pathways, the inference being that the average GP mightn't be up to it. GPs were offended, but the SHAs were concerned by the European comparisons and by other research such as Why Children Die (CEMACH 2008) which highlighted issues about the competency of all frontline practitioners, including GPs. GPs were upset and said so, but frank indignation isn't enough.
A vital part of the profession's response is to develop GPs with a specialist knowledge of paediatrics. These GPs would drive up and monitor standards and activity in whatever practice or consortium they worked in, but they wouldn't replace the need for regular GPs to see and manage the vast majority of children. Such a model of working isn't new. I work as a named GP for child protection, training and supporting GPs and practices to safeguard children, and no-one expects every safeguarding concern to come my way.
Paediatric GPs would work similarly, disseminating the child health strategy currently being developed by the RCGP, looking not only at the management of the sick and injured child, but at issues around mental health, access to services for young people, safeguarding, palliative care, ‘team around the child' activity, etc etc. – there is much to be done.
The RCGP has fended off concerns from secondary care colleagues who have been keen to extend their influence into primary care, but now the profession must deliver. Specialist GPs are a key part of the profession's response, and would help to up-skill and augment, not de-skill and fragment. Mandatory paediatric training of all GP registrars will further bolster rank and file competency.
The needs of the child must be at the centre of the debate, and GPs have no divine right to attend to them. The only right at stake is the right of the child to access the best healthcare, and a properly trained and motivated general practice is best placed to deliver it.
Dr David Jones is a GP clinical advisor on children and family services, NHS North of Tyne